Does workforce explain the relationship between funding and patient experience? A mediation analysis of primary care data in England

Salant, Natasha; Massou, Efthalia; Awan, Hassan; Ford, John Alexander

Abstract

Objectives: To determine whether general practitioner (GP) workforce contributes to the link between practice funding and patient experience. Specifically, to determine whether increased practice funding is associated with better patient experience, and to what degree an increase in workforce accounts for this relationship.

Setting: Primary care practice level analysis of workforce, funding and patient experience of all NHS practices in England.

Primary and secondary outcome measures: The link between NHS-provided funding to general practice (payments per patient) and patient experience, as per the General Practice Patient Survey, was evaluated. Subsequently, mediation analysis, adjusted for covariates, was used to scrutinise the extent to which GP workforce accounts for this relationship (measured as the number of GPs per 10 000 patients).

Participants: We included all general practices in England for which there was relevant data for each primary variable. Atypical practices were excluded, such as those with a patient list size of 0 or where the workforce variable was recorded as being more than 3 SD from the mean. After exclusion, 6139 practices were included in the final analysis.

Results: We found that workforce (GPs per 10 000 population) significantly (p<0.001) acts as a mediator in the effect of practice funding on overall patient experience even after adjusting for rurality, sex and age, and deprivation. On average, the mediated effect constitutes 30% of the total effect of practice funding on patient experience.

Conclusions: The increase in the number of doctors in primary care in England appears to be a mechanism through which augmented practice funding could positively impact patient experience. Policy initiatives targeting improved patient experience should prioritise considerations related to workforce and practice funding.

Citation

Salant, N., Massou, E., Awan, H., & Ford, J. A. (2024). Does workforce explain the relationship between funding and patient experience? A mediation analysis of primary care data in England. BMJ Open, 14(2), Article e072498. https://doi.org/10.1136/bmjopen-2023-072498

• Journal Article Type: Article
• Acceptance Date: Jan 25, 2024
• Online Publication Date: Feb 19, 2024
• Publication Date: Feb 1, 2024
• Deposit Date: Feb 26, 2024
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 2
• Article Number: e072498
• DOI: https://doi.org/10.1136/bmjopen-2023-072498
• Keywords: quality in health care, statistics & research methods, primary health care
• Public URL: https://keele-repository.worktribe.com/output/756356
• Publisher URL: https://bmjopen.bmj.com/content/14/2/e072498